Infraclavicular Block

6 Infraclavicular Block




Perspective


Infraclavicular brachial plexus block is often used for patients requiring prolonged brachial plexus analgesia and is increasingly used for surgical anesthesia by modifying it into a single-injection technique. Anesthesia or analgesia with this technique results in a “high” axillary block. Thus, it is most useful for patients undergoing procedures on the elbow, forearm, or hand. Like the axillary block, this technique is carried out distant from both the neuraxial structures and the lung, thus minimizing complications associated with those areas (see Video 6: Infraclavicular Nerve Block on the Expert Consult Website). image






Traditional Block Technique



Placement




Anatomy


At the level of the proximal axilla, where infraclavicular block is performed, the axilla is a pyramid-shaped space with an apex, a base, and four sides (Fig. 6-1A). The base is the concave armpit, and the anterior wall is composed of the pectoralis major and minor muscles and their accompanying fasciae. The posterior wall of the axilla is formed by the scapula and the scapular musculature, the subscapularis and the teres major. The latissimus dorsi muscle abuts the teres major muscle to form the inferior aspect of the posterior wall of the axilla (Fig. 6-1B). The medial wall of the axilla is composed of the serratus anterior muscle and its fascia, and the lateral wall is formed by the converging muscle and tendons of the anterior and posterior walls as they insert into the humerus (see Fig. 6-1B). The apex of the axilla is triangular and is formed by the convergence of the clavicle, the scapula, and the first rib. The neurovascular structures of the limb pass into the pyramid-shaped axilla through its apex (Fig. 6-2A).



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May 31, 2016 | Posted by in ANESTHESIA | Comments Off on Infraclavicular Block

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